Octopus info

[Octopus]

1- What is your gender?
female

2- Why did you take antidepressants in the first place? and for how long were you on them? which med?
for general anxiety, social anxiety, depression. I first started taking Prozac when I was six years old. It worked pretty well for me and I took a variety of different antidepressants throughout adolescence and up through my early twenties. I was never good at sticking to them post-puberty because of the sexual side effects, which would always cease upon discontinuation. The last time I was on Prozac (along with Lamictal and Focalin) for a few years I think, I don’t remember exactly how long, and I quit taking it in 2013 because I couldn’t cope with the sexual side effects anymore. But the sexual side effects didn’t go away when i quit taking it and I’ve had PSSD since then.

3- How was your sexual and emotional function before antidepressant intake?
I have unrelated vulvodynia which I have had since before I had PSSD but other than that my sexual function was normal, even when depressed. I had a high libido and could experience sexual pleasure and good orgasm (even when intercourse was not an option). Emotional function is trickier to describe—I’ve always had a lot of ups and downs but it seems like the ups aren’t as up since PSSD.

4- What are your symptoms exactly and when did they start? sexual dyfunction alone, or cognitive/emotional/hedonistic as well? which symptom is bothering you the most?
Sexual symptoms are the most bothersome for me—muted orgasm, loss of libido, and genital numbness (not literally numb, but numb to sexual pleasure). An interesting thing is that in the past when I took SSRIs, the sexual side effect I had was inability to orgasm (but not genital numbness). The last time I took Prozac however, and ever since then, I could and can still have an orgasm (though it is harder to achieve) but the main thing is the genital numbness and the fact that the orgasm doesn’t really feel good.
It’s hard for me to measure my emotional state now to where it was pre—PSSD. I was in my early twenties when I first started taking Prozac for the last time, early thirties now. When I first found out I had PSSD it was REALLY bad for the first couple years and I think part of that was psychological—it was really traumatic for me realizing what had happened and took a while to come to terms with it. I thought I maybe had emotional/cognitive symptoms from it, but now I think it’s just as likely mental illness and life having beaten me down (so if you happen to have any idea of what I could take to ease my crippling anxiety while you're at it let me know!) Like I said, ups seem not as high, but I can still feel joy sometimes, I’m not completely anhedonic. However the sexual symptoms I feel confident are from the medication.

5- What meds/suppplements have you tried so far?
The only thing that has helped has been Wellbutrin. I’ve been taking 150mg per day for about a year now. It was working for me—not a complete reversal of symptoms but definitely an improvement. However about 2 weeks ago it stopped working. So that’s troubling. Other things I’ve tried include Huperzine, Choline, marijuana, MSM, inositol, Bacopa, Buspar…probably some other things that I can’t think of right now but none of those things helped. I also started taking cbd oil recently. I really wanted to try Addyi but it is prohibitively expensive for me.

6- Do you have access to meds without prescription (buy online), or would strictly require a prescription for meds to try?
I would prefer to get it through a prescription and I’ve never had a problem getting a prescription when I ask for it, but if you have an outside the box idea for me I’d be interested in hearing/trying that too!

7- Can you tolerate galicky foods? what about proteins?
Yes, I think so. Haven't had any issues.

8- Have you done any blood testing? what were the results?
Yes. Found this in a post of mine from 2017, I think this is the most recent blood test results I have (I think I was in the Luteal phase):
LH: 13.8 mIU/mL (normal range Follicular: 2.3 - 12.9 Mid-cycle: 9.1 - 76.7 Luteal: 0.6 - 17.3)
FSH: 4.7 mIU/mL (normal range Follicular 3.3 - 11.3 Mid-cycle 5.2 - 20.4 Luteal 1.8 - 8.2)
TSH: 2.61 mcIU/mL (normal range: 0.40 - 4.50 mcIU/mL)
DHEA SO4: 190 mcg/dL (normal range 35-341 mcg/dL)
Progesterone: 1.4 ng/mL (normal range: Follicular <0.2 - 0.9 ng/mL Luteal 2.7 - 21.1 ng/mL)
17-Hydrosyprogesterone 78.10 ng/dL (normal range: Follicular 15 to 70 ng/dL Luteal 35 to 290 ng/dL)
Androstenedione 144 ng/dL (normal range: 30-200 ng/dL)
Estradiol (E2) 92.6 pg/mL (normal range: Follicular 20-144 Mid-cycle 64-357 Luteal 56-214 Post-menopausal <=32)
Pregnenolone 63 ng/dL (normal range 15-132ng/dL)
Prolactin 24.8 ng/mL (normal range: Non pregnant: 3.0-30.0 ng/mL)
Dihydrotestosterone 11ng/dL (normal range 4-22)
Sex Hormone Binding Glob 50 nmol/L (normal range 18-114 nmol/L)
Albumin 4.5 g/dL (normal range 3.5-5.1 g/dL)
Testosterone Total 40ng/dL (normal range 9-55 ng/dL)
Testosterone Calc Free 5.0 pg/mL (normal range 0.8-7.4 pg/mL)
Testosterone Calc Free % 1.3% (normal range 1.6-2.9 %)
Testosterone Calc Bioav 14.0 ng/dL (normal range 2.2-20.6 ng/dL)
testosterone Calc Bioav 35.0%

[Meso]

Your hormonal values seem fine. I think Bupropion stopped helping due to postsynaptic 5HT1A downregulation and nNOS inhibition. Nitric oxide pathway is important for females as well. How is your erectile function? (clitoral). Do you feel that blood supply to that area has diminished? or is there a shrinkage?

I suggest trying Saint John's Wort for a while while on Bupropion.

[Octopus]

Everything looks fine and the same down there and every time I see my gynecologist she says it looks healthy. I do remember hearing her say my clitoris looked a little small, but I think it’s always looked like that (I didn’t see this doc til after I had PSSD so she wouldn’t know if it looked different). So no, I don’t think there is any shrinkage or issues with blood flow. I also just remembered at one point my gynecologist gave me a testosterone/estrogen cream to put on my clitoris to increase sensation. I didn’t see any results from that either.

I’d be willing to give St. John’s Wort a try. I think I’ve taken it before but I think that was pre-pssd. I’m not sure and I wish I would have been more methodical about documenting my drug trials (I’m going to try to be better about this, I just downloaded a medication/symptom tracker app). I think I was hesitant about trying sjw for PSSD because my limited understanding was that SJW works similar to an SSRI. But I just looked through this thread and I can see that some people have had success with it http://www.pssdforum.com/viewtopic.php? ... &hilit=sjw

Do you have an opinion on dosage or cycling versus just taking the same amount every day? If St. John’s Wort does work for me, I don’t want to risk having it poop out on me after a few months like the Wellbutrin did. I’m seeing my PCP next week so I’ll consult with her about it as well. I’m also hoping she’ll give me some klonopin or something to take every once in a while for those very high anxiety/panic attack situations…

[Meso]

Do you have an opinion on dosage or cycling versus just taking the same amount every day? If St. John’s Wort does work for me, I don’t want to risk having it poop out on me after a few months like the Wellbutrin did. I’m seeing my PCP next week so I’ll consult with her about it as well. I’m also hoping she’ll give me some klonopin or something to take every once in a while for those very high anxiety/panic attack situations…

SJW upregulates the receptors that Bupropion potentially downregulated. So it could restore Bupropion's benefits and there shouldn't be any tolerance issue.

SJW also raises GABA and should overall lessen anxiety and panic. I suggest 300 mg twice per day as an initial dose for a week and then we should see about altering the dose later on.

[Octopus]

Ok great, thanks. Just got my SJW in the mail yesterday. I'm starting off with just 300mg per day for the first few days, then I'll bump it up to 300mg 2x daily. If this could actually help with anxiety and PSSD that would be amazing! I'll keep you posted whatever happens.

[Octopus]

Hey there, so I started taking St. John’s wort 300mg at first then bumped it up to 600mg a few days ago. I haven’t noticed any effects on anxiety or sex stuff, but I’ve been having worse and more frequent migraines the past week or so and I’ve basically had a non-stop headache since Friday which is when I upped the dose. Is there any way St. John’s wort could be making my migraines worse or is it just a coincidence do you think? Last year when I tried increasing the dose of Wellbutrin I ended up having worse migraines and had to decrease the dose again

[Octopus]

Hey, just a quick update: After the migraine from hell last weekend I quit taking St. John’s Wort. I also made an appointment to see the headache doctor but I won’t get in to see her for another month. She was talking about Zonegran last time I saw her so I may start taking that, I don’t know. I don’t want a ton of drugs that I have to take daily if I can help it, I get nervous about drug interactions. (Another thing I noticed when I was looking stuff up is that the medication I currently take when I get a migraine, Naratriptan, is a serotonin receptor agonist. So I don’t know if it’s bad to take that with SJW which is technically an SSRI?)

I also decided to take a break from Wellbutrin. Since I can’t seem to tolerate SJW, I thought maybe if I quit taking Wellbutrin for a few weeks and then start taking it again, maybe I would start to see the benefits again? I don’t know if that’s a dumb idea but it’s the best idea I have right now. I’ll be eager to hear your thoughts/suggestions when you’re feeling up to it—I know you’ve got a lot on your plate at the moment. I was also thinking I might start taking Capsaicin supplements, based on the recommendation you gave to others. I expect I’ll continue to update this thread with any new developments. Take care.

[Meso]

Hey, just a quick update: After the migraine from hell last weekend I quit taking St. John’s Wort. I also made an appointment to see the headache doctor but I won’t get in to see her for another month. She was talking about Zonegran last time I saw her so I may start taking that, I don’t know. I don’t want a ton of drugs that I have to take daily if I can help it, I get nervous about drug interactions. (Another thing I noticed when I was looking stuff up is that the medication I currently take when I get a migraine, Naratriptan, is a serotonin receptor agonist. So I don’t know if it’s bad to take that with SJW which is technically an SSRI?)

I also decided to take a break from Wellbutrin. Since I can’t seem to tolerate SJW, I thought maybe if I quit taking Wellbutrin for a few weeks and then start taking it again, maybe I would start to see the benefits again? I don’t know if that’s a dumb idea but it’s the best idea I have right now. I’ll be eager to hear your thoughts/suggestions when you’re feeling up to it—I know you’ve got a lot on your plate at the moment. I was also thinking I might start taking Capsaicin supplements, based on the recommendation you gave to others. I expect I’ll continue to update this thread with any new developments. Take care.

Zonisamide (Zonigran) is a good medication for migraines but keep in mind that migraine meds take a while to work, so be patient. Naratriptan doesn't raise serotonin level so it's safe to combine with low dose SJW. Serotonin syndrome usually involves an SSRI + SJW, predisposing the patient to SS with a triptan being the final stone.

As for SJW triggering migraines, it's unlikely. Current research says that it actually helps with migraines and migraine pain:
https://www.ncbi.nlm.nih.gov/pubmed/23578992
https://www.ncbi.nlm.nih.gov/pubmed/28137525

Keep us updated.

[Octopus]

Thanks, I think you’re right about SJW not being to blame for migraines—I seem to go through periods where I experience worse migraines just like I go through periods with worse PSSD and it’s frustrating being unable to figure out what is causing it. I try to look for patterns but more often than not it just seems random to me.

Right now I am now taking 50mg Zonisamide and 450mg Cayenne pepper daily. I am planning on taking Wellbutrin and SJW again, but I’m going to wait a few weeks to see what the effects of the meds I’m on now are.

[Octopus]

I've been taking the following meds for a little over a week now:
bupropion hcl xl 150mg once a day
St. john's wort 300mg 2x daily
cayenne pepper 450mg once a day

I'm not taking any other meds right now. I haven't noticed any major changes, perhaps a slight increase in libido. I've also been having more headaches since I started taking Wellbutrin again. I was basically headache free for the past couple months prior when I wasn't taking anything. Could be a coincidence, I'll keep taking it for now and see what happens. Mesolimbo, you had mentioned adjusting the dose after the first week so I'm just wondering if you have any advice on where to go from here. Thanks